Journal of Emergency Medicine最新文献

{"title":"Critical Appraisal of “Comparative Efficacy and Safety of Intravenous Vasopressors in Pre-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis”","authors":"Raihan Mohammed Mohiuddin, Mohammed Misbah Ul Haq","doi":"10.1016/j.jemermed.2025.10.038","DOIUrl":"10.1016/j.jemermed.2025.10.038","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"81 ","pages":"Pages 93-94"},"PeriodicalIF":1.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146119228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Ultrasound Image Quality Between Users on a Novel Automated Device for Extremity Injury","authors":"Christopher Thom MD, RDMS ,&nbsp;Vietvuong Vo MD ,&nbsp;Jakob Ottenhoff DO ,&nbsp;Colleen Mullins BA ,&nbsp;Ashley Simpson MS, CCRC ,&nbsp;Sarah Homan BS ,&nbsp;Lauren Kerich BS ,&nbsp;Laura Vargas Ortiz BS ,&nbsp;Diana Hamza MS ,&nbsp;Philip Jarrett MD, MBA","doi":"10.1016/j.jemermed.2025.11.011","DOIUrl":"10.1016/j.jemermed.2025.11.011","url":null,"abstract":"<div><h3>Background</h3><div>Plain radiography traditionally serves as the first-line imaging modality for extremity injuries. However, x-rays have limitations in subtle fracture detection and soft tissue visualization. Ultrasound represents an alternative modality with potential diagnostic benefit but requires substantial operator expertise.</div></div><div><h3>Objective</h3><div>We sought to evaluate the image quality and patient comfort associated with a novel volumetric ultrasound system (Accuro XV) that intends to automate imaging acquisition. Scans obtained by clinical research assistants (CRAs) were compared to those obtained by board-certified emergency physicians.</div></div><div><h3>Methods</h3><div>This was a prospective, multi-site study of patients aged 5 and older presenting with acute ankle or wrist trauma. 205 subjects were enrolled, each undergoing x-ray and Accuro XV imaging. Pain levels were assessed using a Numerical Rating Scale. Fifty CRA and 50 physician-acquired studies were randomly selected for blinded image quality analysis.</div></div><div><h3>Results</h3><div>There was no significant difference in image quality between CRA and physician groups (mean scores 3.6 vs. 3.7; <em>p</em> = 0.24), with over 90% of studies rated as diagnostically adequate. Interrater reliability amongst reviewers was moderate (intraclass correlation coefficient 0.53–0.56). Pain scores were similar with both showing minimal discomfort (median pain increase during imaging of 0; interquartile range 0–1).</div></div><div><h3>Conclusion</h3><div>This study demonstrates the feasibility of high-quality extremity ultrasound imaging using the Accuro XV device, including by nonphysician operators with minimal training. The technology shows potential for broader adoption in acute care with nonphysician operators. Further studies are warranted to evaluate diagnostic accuracy and clinical impact.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"81 ","pages":"Pages 9-18"},"PeriodicalIF":1.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Transition Units on Emergency Department Crowding: A Before-and-After Study","authors":"Mustafa Altun MD ,&nbsp;Emre Kudu MD ,&nbsp;Furkan Yakin MD ,&nbsp;Mehmet Birkan Korgan MD ,&nbsp;Emir Unal MD ,&nbsp;Oguzhan Demir MD ,&nbsp;Eren Onur Karavin MD ,&nbsp;Haldun Akoglu MD","doi":"10.1016/j.jemermed.2025.12.007","DOIUrl":"10.1016/j.jemermed.2025.12.007","url":null,"abstract":"<div><h3>Background</h3><div>Emergency department (ED) crowding is a major operational problem driven by access block. Transition units (TUs) have been proposed to mitigate boarding delays, but their quantitative impact remains insufficiently characterized.</div></div><div><h3>Objectives</h3><div>To evaluate the effect of implementing medical and surgical TUs on ED crowding, measured by the National Emergency Department Overcrowding Scale (NEDOCS).</div></div><div><h3>Methods</h3><div>This single-center prospective study evaluated crowding in a tertiary academic ED before and after TU implementation. NEDOCS scores were prospectively measured 6 times daily between April 23 and May 31, 2025, when both medical and surgical TUs were fully operational. Data from identical calendar periods in 2021 (pre-TU) and 2023 (medical TU only) served as comparators. The primary outcome was the NEDOCS score; secondary outcomes were NEDOCS parameters and categorical level distributions.</div></div><div><h3>Results</h3><div>The median NEDOCS score in 2025 was 85.6 (IQR 66.2–117.0), significantly lower than 2021 (137 [IQR 114.0–173.0]) and 2023 (132 [IQR 108.0–181.0]) (both <em>p</em> &lt; 0.001). Overcrowded or worse conditions (Levels IV–VI) decreased from 81.5% (2021) and 80.6% (2023) to 38.4% (2025) (<em>p</em> &lt; 0.001). Boarding numbers and longest boarding times also fell significantly, whereas overall patient inflow to the ED remained comparable across years.</div></div><div><h3>Conclusions</h3><div>Implementation of dual TUs was associated with substantial reductions in ED crowding severity, as reflected by lower NEDOCS scores and improved operational metrics. Expanding TU capacity across specialties is an effective structural strategy to relieve access block in high-volume EDs.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"81 ","pages":"Pages 68-77"},"PeriodicalIF":1.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146024630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Use of Point-of-Care Ultrasound for Suspected Traumatic Thyroid Gland Rupture","authors":"Yuya Kitai MD ,&nbsp;Ryota Sato MD ,&nbsp;Risako Kurabayashi MD ,&nbsp;Tetsuya Inoue MD, PhD","doi":"10.1016/j.jemermed.2025.11.005","DOIUrl":"10.1016/j.jemermed.2025.11.005","url":null,"abstract":"<div><h3>Background</h3><div>Thyroid gland rupture is extremely rare, typically occurring in individuals with underlying thyroid enlargement or hyperthyroidism. Thyroid gland rupture can lead to life-threatening complications such as airway obstruction or thyroid storms.</div></div><div><h3>Case Report</h3><div>A 19-year-old male with no past medical history presented to the emergency department (ED) with painful swelling in the anterior neck after blunt neck trauma. The patient reported pain while swallowing but denied dyspnea or difficulty swallowing. Point-of-care ultrasound (POCUS) of the anterior neck area revealed hypo-echoic hematoma in the right lobe of the thyroid gland. A subsequent computed tomography (CT) scan with intravenous contrast confirmed that the right lobe of thyroid was enlarged with no contrast enhancement in the center of the right lobe. A thyroid gland rupture was finally diagnosed.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>Emergency physicians should consider this rare but potentially serious injury in patients with blunt neck trauma and tailor the management based on the extent of thyroid damage, risk of airway compromise, and thyroid function status. This case suggests that POCUS can be a powerful tool when clinicians suspect thyroid gland rupture.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"81 ","pages":"Pages 1-4"},"PeriodicalIF":1.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145928863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sociodemographic Disparities in Emergency Department Wait Times at an Urban Academic Medical Center","authors":"Kaytlena Stillman MD, MPH ,&nbsp;Lea Dahlke BS ,&nbsp;James Mirocha MS ,&nbsp;Hudson Stuck BS ,&nbsp;Christina Harris MD ,&nbsp;Joel Geiderman MD ,&nbsp;Sam Torbati MD","doi":"10.1016/j.jemermed.2025.11.006","DOIUrl":"10.1016/j.jemermed.2025.11.006","url":null,"abstract":"<div><h3>Background</h3><div>Long emergency department (ED) waiting room times are associated with increased morbidity and mortality.</div></div><div><h3>Study Objective</h3><div>This study sought to determine if sociodemographic disparities exist in ED waiting room times at a single institution.</div></div><div><h3>Methods</h3><div>This retrospective observational study was conducted at a single center ED between July 1 and December 31, 2023. The main outcome was door-to-provider (DTP) time. Variables included basic demographic information, ED visit characteristics, social risks, and prior healthcare utilization. Trauma activations and patients who “left without being seen” were excluded. Two separate analyses were conducted: 1) for patients with DTP times of less than or equal to 6 h (n = 34,385), and 2) a comparison of these patients to those with DTP times greater than 6 h (n = 4363).</div></div><div><h3>Results</h3><div>For patients with DTP times less than or equal to 6 h, incidence rates of having a 1 h longer DTP time was greater for females compared to males (incidence rate ratios [IRR] 1.02, 95% confidence interval [CI] 1.01–1.04), Hispanic compared to non-Hispanic patients (IRR 1.02, 95% CI 1.01–1.04), and Black compared to White patients (IRR 1.03, 95% CI 1.01–1.05). Odds of having a DTP time greater than 6 h was higher for females compared to males (odds ratio [OR] 1.14, 95% CI 1.06–1.22), Hispanic compared to non-Hispanic patients (OR 1.26, 95% CI [1.15–1.38), Black compared to White patients (OR 1.35, 95% CI [1.24–1.48), and homeless compared to housed patients (OR 1.46, 95% CI 1.23–1.72).</div></div><div><h3>Conclusion</h3><div>This single-center study found that female sex, Hispanic ethnicity, Black race, and homelessness were associated with longer ED wait times.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"81 ","pages":"Pages 30-38"},"PeriodicalIF":1.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146024631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When the Skin Lies: Occult Scalp Necrotizing Fasciitis After Blunt Head Trauma","authors":"Mehmet Yorgun MD ,&nbsp;Mahmut Şahin MD ,&nbsp;Anıl Mert Güleryüz MD ,&nbsp;Osman Taş MD","doi":"10.1016/j.jemermed.2025.12.016","DOIUrl":"10.1016/j.jemermed.2025.12.016","url":null,"abstract":"<div><h3>Background</h3><div>Scalp necrotizing fasciitis (NF) is an exceptionally rare and potentially fatal soft-tissue infection. Early recognition of the condition is challenging in cases where classical skin changes are absent.</div></div><div><h3>Case Report</h3><div>A 59-year-old male patient suffering from diabetes mellitus presented with a foul-smelling purulent discharge from a scalp wound that had been sutured ten days prior following a fall from a height of three meters. Notwithstanding the absence of necrosis, bullae, or crepitus, laboratory tests demonstrated leukocytosis (white blood cells [WBC] 16,120/µL) and elevated C-reactive protein (337 mg/L). Cranial Computed Tomography (CT) revealed diffuse subcutaneous emphysema and fascial thickening extending from the frontal to occipital region. The surgical exploration was performed in an urgent manner, which resulted in the exposure of necrotic fascia with purulent exudate. Subsequent histopathological analysis provided definitive confirmation of NF. The presence of polymicrobial infection involving Acinetobacter spp. and Staphylococcus aureus was identified. Following comprehensive debridement and the administration of broad-spectrum antibiotics, the patient exhibited a complete recovery.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>NF of the scalp can present deceptively, with normal-appearing skin despite deep fascial necrosis. The presence of subcutaneous gas on imaging in patients with diabetes who have sustained trauma should prompt immediate surgical consultation. It is imperative to recognize that early suspicion and multidisciplinary action can be life-saving.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"81 ","pages":"Pages 78-82"},"PeriodicalIF":1.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146024694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on “Age-Adjusted D-Dimer vs. Traditional D-Dimer to Rule Out Acute Aortic Syndromes”","authors":"Chien-Chieh Hsieh PhD ,&nbsp;Fu-Shan Jaw PhD ,&nbsp;Po-An Chen MD","doi":"10.1016/j.jemermed.2025.11.013","DOIUrl":"10.1016/j.jemermed.2025.11.013","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"81 ","pages":"Pages 95-96"},"PeriodicalIF":1.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146119164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Structural Concerns Regarding Scientific Neutrality and Methodology in: “Emergency Department Preparedness in a Mega Mass Casualty Incident While Under Missile Fire: Lessons Learned from Israel on October 7, 2023”","authors":"Abdul Samet Sahin MD","doi":"10.1016/j.jemermed.2025.09.006","DOIUrl":"10.1016/j.jemermed.2025.09.006","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 321-322"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145972799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Clinical Outcomes of Trauma Transport: Emergency Medical Services vs. Police Transport, A Systematic Review and Meta-Analysis","authors":"Vadym Shapovalov MD ,&nbsp;Quincy K. Tran MD, PhD ,&nbsp;Babak Sarani MD ,&nbsp;Mohammed Zohery BS ,&nbsp;Amy Caggiula MD ,&nbsp;Rahil Ashraf MS ,&nbsp;Ali Pourmand MD, MPH, RDMS","doi":"10.1016/j.jemermed.2025.10.013","DOIUrl":"10.1016/j.jemermed.2025.10.013","url":null,"abstract":"<div><h3>Background</h3><div>In many urban settings, police transport (PT) is increasingly used as an alternative to traditional Emergency Medical Services (EMS). PT follows a “scoop and run” strategy, aiming to minimize prehospital interventions to rapidly deliver patients to the nearest trauma center. Conversely, EMS teams typically provide stabilizing medical care on site before transport.</div></div><div><h3>Objectives</h3><div>This study aimed to compare outcomes, specifically rates of surgical intervention and mortality, for patients transported by police vs. EMS.</div></div><div><h3>Methods</h3><div>PubMed, Scopus, and Cochrane databases were searched from inception to January 1, 2025 for studies meeting inclusion criteria. A random-effects meta-analysis was performed to assess the primary outcome of mortality for PT vs. EMS, and the secondary outcome of surgical intervention in penetrating injuries. Study quality was evaluated using the Newcastle-Ottawa Scale; heterogeneity was assessed with Q-statistics and <em>I</em>² values.</div></div><div><h3>Results</h3><div>Ten studies met criteria, totaling 112,570 patients: 100,716 (89%) transported via EMS and 11,854 (11%) by police. All-cause mortality was 13% (12,742/100,716) for EMS patients vs. 25% (2922/11,854) for PT patients. Police transport was associated with a 1.5-fold higher mortality rate (odds ratio 1.50, 95% confidence interval 1.34–1.69, <em>p</em> &lt; 0.001). No statistically significant difference was found in surgical intervention rates for penetrating injuries (odds ratio 1.19, 95% confidence interval 0.98–1.45, <em>p</em> = 0.082). Heterogeneity was significant for both mortality (<em>I</em>² = 66%) and surgical interventions (<em>I</em>² = 74%).</div></div><div><h3>Conclusion</h3><div>Police transport was associated with higher odds of all-cause mortality compared with EMS, with no difference in surgical intervention rates. Prospective, methodologically robust studies are needed to guide future practice.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 8-19"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145546580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of 2023 Centers for Medicare and Medicaid Services (CMS) Guidelines on Point-of-Care Emergency Ultrasound Billing","authors":"Emily Cen MD ,&nbsp;Karla Kingsbury BFA ,&nbsp;Larry Amaya CPC ,&nbsp;Wioletta Kwolek ABM, CPC ,&nbsp;Mamta Shrestha BA, CPC ,&nbsp;Di Coneybeare MD, MHPE","doi":"10.1016/j.jemermed.2025.10.015","DOIUrl":"10.1016/j.jemermed.2025.10.015","url":null,"abstract":"<div><h3>Background</h3><div>The 2023 Centers for Medicare and Medicaid Services (CMS) billing guidelines allowed a refocus on medical decision-making, the risk of morbidity, and overall medical complexity. It is uncertain how point-of-care ultrasound (POCUS) billing has been affected by these changes. Elucidation of how 2023 CMS changes to POCUS billing can allow us to ensure alignment with best practices.</div></div><div><h3>Objective</h3><div>To investigate the effect of the 2023 CMS changes on POCUS billing.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study performed at a large urban quaternary care center. The baseline characteristics of patients and volume of documented POCUS, as well as by Current Procedural Terminology (CPT) codes and reimbursement rates in 2022 and 2023, were compared. We also evaluated the proportion of charts in which POCUS was incorporated into medical decision-making in 2 months in 2023.</div></div><div><h3>Results</h3><div>In total, there were 2900 and 2778 patient encounters with at least one POCUS documentation in 2022 and 2023, respectively. There was no difference in the volume of POCUS billed monthly, or CPT codes of billed POCUS between 2022 and 2023 (<em>p</em> = 0.47 and 0.90, respectively). Reimbursement rates for separately billed POCUS procedures remained unchanged, with an exception to private insurance, where reimbursement rate increased slightly (<em>p</em> = 0.011). There was a small proportion of visits (4.1%) in which POCUS billing affected the evaluation and management code for the emergency department visit.</div></div><div><h3>Conclusions</h3><div>The 2023 CMS changes to billing have not significantly changed billing practices for POCUS.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 145-151"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145587834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}